Creatine : Dosing and Safety

by MedlinePlus

(Page 2 of 3)

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization:

Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. Various creatine products contain different forms (creatine monohydrate, creatine monophosphate) in varying concentrations, as well as creatine in combination with other supplements. There are no standard doses of creatine, and many different doses are used.

Adults (18 years and older):

Note: Creatine appears to be best absorbed as a solution, although ingestion as meat or in solid form is also readily absorbed. Elevation of muscle creatine levels may best be achieved by taking creatine with carbohydrates. Experts often recommend maintaining good hydration during creatine use.

Oral (powder): A wide range of dosing has been used or studied.

Enhanced athletic performance- 9-20 grams daily in divided doses for 4-7 days has been used, with maintenance doses ranging between 2-5 grams daily or 0.3 milligrams per kilogram of body weight daily.

Cholesterol reduction- 20-25 grams daily for 5 days followed by 5-10 grams thereafter has been used.

Hyperornithinemia- 1.5 grams daily has been used

Neuromuscular diseases- including muscular dystrophy, 10 grams daily has been suggested, although lower doses (5 grams) and higher doses (20 grams) have also been used.

GAMT deficiency, 400-670 milligrams per kilogram of body weight daily has been used.

Congestive heart failure- 20 grams per day has been studied.

Symptomatic treatment in ALS- 20 grams daily for 7 days then 3 grams daily for 3-6 months has been used.

McArdle's disease- 150 milligrams per kilogram of body weight has been used daily for five days, followed by 60 milligrams per kilogram daily for 5 weeks.

Intravenous/intramuscular: Numerous dosing regimens have been used in studies in humans. Intravenous dosing should be conducted only under strict medical supervision.

Children (younger than 18 years):

Dosing in children should be under medical supervision because of potential adverse effects. A dose of 5 grams daily has been used in children with muscular dystrophy, and various doses have been used in children with GAMT deficiency, including 2 grams per kilogram of body weight, 4-8 grams daily in an infant, and 400-670 milligrams per kilogram of body weight.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Creatine has been associated with asthmatic symptoms. People should avoid creatine if they have a known allergy to this supplement.

Side Effects and Warnings

There is limited systematic study of the safety, pharmacology, or toxicology of creatine. Individuals using creatine, including athletes, should be monitored by a healthcare professional. Users are advised to inform their physician or other healthcare professional.

Some individuals may experience gastrointestinal symptoms, including loss of appetite, stomach discomfort, diarrhea, or nausea.

Creatine may cause muscle cramps or muscle breakdown, leading to muscle tears or discomfort. Weight gain and increased body mass may occur. Heat intolerance, fever, dehydration, reduced blood volume, or electrolyte imbalances (and resulting seizures) may occur.

There is less concern today than there used to be about possible kidney damage from creatine, although there are reports of kidney damage, such as interstitial nephritis. Patients with kidney disease should avoid use of this supplement. Similarly, liver function may be altered, and caution is advised in those with underlying liver disease.

In theory, creatine may alter the activities of insulin. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare professional, and medication adjustments may be necessary.

Chronic administration of a large quantity of creatine is reported to increase the production of formaldehyde, which may potentially cause serious unwanted side-effects.

Based on a case report, creatinine may increase the risk of compartment syndrome of the lower leg, a condition characterized by pain in the lower leg associated with inflammation and ischemia (diminished blood flow), which is a potential surgical emergency.

Pregnancy and Breastfeeding

Creatine cannot be recommended during pregnancy or breast-feeding due to a lack of scientific information.

Pasteurized cow's milk appears to contain higher levels of creatine than human milk. The clinical significance of this is not clear.

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